The late Helen Lester, in her 2012 Royal College of General Practitioners (RCGP) Annual General Meeting James Mackenzie lecture ‘Being Bothered about Billy’, implored primary care physicians to make the proactive recognition and treatment of physical health conditions in people with severe mental illness (SMI) core business, particularly cardiometabolic comorbidity.

SMIs, including schizophrenia and bipolar disorder, affect around 3% of the population over the life course,1 and carry a shortened life expectancy of about 15 years.2 Early death is most often due to preventable conditions such as cardiovascular disease (CVD), diabetes, and obesity, which are multifactorial in nature.3 The extent of the physical comorbidity of SMI has led to calls for psychosis to be repositioned as a ‘multisystem disorder’, particularly since the consequences of the physical manifestations of SMI may outweigh those arising from the brain.4

The cardiometabolic comorbidity of SMI starts early (Figure 1). Whereas disturbances such as impaired glucose tolerance and diabetes, hypertension, and dyslipidaemia tend to emerge around middle age in the general population, in people …